Creativity in Containing a Patient’s High-Output Fistula: A Case Report
A gastrogastric fistula is a rare complication of Roux-en-Y gastric bypass resulting from communication between the gastric pouch and gastric remnant. This case report describes the creative interprofessional management of this condition arising in a 48-year-old woman. During an elective Roux-en-Y gastric bypass surgery for morbid obesity, the patient developed respiratory complications. She was admitted to the ICU, but the following day she signed herself out against medical advice, stating she was “no longer staying here.” Within 24 hours, she returned to the ED for postoperative complications, and a week after the exploratory surgery, the patient developed an inoperable high-output fistula. The authors devised a creative solution to contain the effluent and achieved closure of the fistula after several weeks.
Superior mesenteric artery (SMA) syndrome, Wilkie ’s or Cast Syndrome is a rare disease which was first described in 1842. It is seen in patients most often after dramatic weight loss due to starvation, burns, anorexia nervosa, or after bariatric surgery.
To assess long-term alterations in circulating magnesium status after Roux-en-Y gastric bypass surgery, RYGB, and associations with remission of type 2 diabetes (T2D).Research design and methods: Retrospective analysis of five year outcome of plasma magnesium (p-Mg) and glucometabolic status in patients who underwent primary RYGB and who completed the annual follow-up program. Data from 84 patients without diabetes and 62 with T2D before RYGB showing prolonged remission (n=30), temporary remission (n=16) or no remission (n=16) after surgery were investigated.
Authors: Boru CE, Termine P, Antypas P, Iossa A, Ciccioriccio MC, De Angelis F, Micalizzi A, Silecchia G Abstract BACKGROUND: Hiatal hernia repair (HHR) is still controversial during bariatric procedures, especially in case of laparoscopic sleeve gastrectomy (LSG). AIMS: to report the long-term results of concomitant HHR, evaluating the safety and efficacy of posterior cruroplasty (PC), simple or reinforced with biosynthetic, absorbable Bio-A® mesh (Gore, USA). Primary endpoint: PC's failure, defined as symptomatic HH recurrence, nonresponding to medical treatment and requiring revisional surgery. METHO...
Roux-en-Y gastric bypass (RYGB) affords a long-term, durable approach to the management of diabetes mellitus (DM) in morbidly obese patients. Nevertheless, patients with DM are at an increased risk for 30-day wound events and additional morbidity and mortality compared with patients without DM. The purpose of our study was to determine if there is a preoperative glycosylated hemoglobin (HgA1c) target level that can be used as a surrogate for optimization of DM in diabetic patients before RYGB.
AbstractAfter Roux-en-Y gastric bypass, leaks from gastro-jejunostomies represent serious morbidity. Situations where large defects develop on small gastric pouches present particular surgical challenges. Here, we report the case of a 43-year-old female who presents with a large gastric leak after conversion of sleeve gastrectomy to Roux-en-Y gastric bypass due to staple lines having crossed. The aim of thisvideo is to present the management of gastrojejunal leak after Roux-en-Y gastric bypass and technical features of circular stapled laparoscopic oesophagojejunal anastomosis.
AbstractThis video case report presents a patient with an invasive pancreatic mass and a history of Roux-en-Y gastric bypass surgery who underwent single-session endoscopic ultrasound-directed transgastric ERCP for tissue sampling and biliary stenting with subsequent maintenance of the newly established gastrogastrostomy. The demonstrated technique enables spectrum of endoscopic interventions in gastric bypass patients by facilitating a direct endoscopic passage through the reconnected stomach. Importantly, the method carries a risk of weight regain by essentially reversing the bypass. However, this can be an actual desire...
ConclusionSIBO may be responsible for postoperative chronic diarrhea in RYGB patients, possibly in the long term, and it is often misdiagnosed. Primary treatment is conservative with appropriate dietary measures, antibiotics, and probiotics but surgical management can be very effective in selected patients presenting with failure of prolonged medical treatment and an anatomic abnormality.